颈椎过伸伤伴多节段椎间盘韧带复合体损伤的诊治分析
Diagnosis and treatment of cervical spine hyperextension injury plus multilevel intervertebral disco-ligamentous complex injury
陈卫 1陈志达 1林斌 1蔡弢艺 1曾宇哲 1丁真奇 1俞张剑 1黄砖枝1
作者信息
- 1. 第九○九医院(厦门大学附属东南医院)骨科,漳州 363000
- 折叠
摘要
目的 探讨颈椎过伸伤伴多节段椎间盘韧带复合体(MDLC)损伤的临床、影像特点及治疗效果.方法 2010年1月至2020年10月间在第九○九医院(厦门大学附属东南医院)骨科住院治疗的颈椎过伸伤患者共456例,回顾性分析其中确诊为MDLC损伤行手术治疗且病历资料完整的43例颈椎过伸伤伴MDLC损伤患者资料.男37例,女6例;年龄(50.6±10.7)岁;按美国脊髓损伤协会(ASIA)分级:A级1例,B级8例,C级18例,D级16例,日本矫形外科学会(JOA)评分为(7.9±1.6)分.42例患者行颈椎前路减压、融合与内固定术,1例患者采用后路全椎板减压内固定术.对患者临床及影像学表现、术前与术中DLC损伤的诊断相符情况进行分析,采用ASIA分级和JOA评分对手术治疗效果进行评定,并与术前进行比较.结果43例患者有99个间隙(C5.6间隙高发,占30例)存在椎间盘韧带复合体(DLC)损伤,48个间隙(C3-4间隙高发,占16例)存在颈髓损伤高信号表现;两节段DLC损伤最常见,占74.4％(32/43),三、四节段DLC损伤分别为9例、2例;跳跃性MDLC损伤21例,连续性MDLC损伤22例.术前存在疑似DLC损伤有10例患者(11个间隙),最终由手术明确DLC损伤8例(9个间隙),排除DLC诊断2例(2个间隙).所有患者术后获(54.7±10.7)个月随访.末次随访时ASIA分级:C级3例,D级13例,E级27例,JOA评分为(15.1±2.2)分,均较术前显著改善,差异均有统计学意义(P＜0.05).结论 颈椎过伸伤合并MDLC损伤的临床发病率低,中老年患者相对易发,DLC损伤与颈髓损伤节段高发的位置存在不一致,对其中可疑损伤的DLC结构进行手术探查可以降低漏诊、误诊率.
Abstract
Objective To investigate the clinical and imaging characteristics of cervical spine hyper-extension injury plus multilevel disco-ligamentous complex(MDLC)injury and the therapeutic effectiveness of their treatment.Methods A total of 456 patients with cervical hyperextension injury were hospitalized be-tween January 2010 and October 2020 at Department of Orthopaedics,The 909th Hospital,Dongnan Hospital Affiliated to Xiamen University.A retrospective study was conducted to analyze the clinical data of the 43 pa-tients among them who had been diagnosed with MDLC injury and undergone surgical treatment and been fully followed up.They were 37 males and 6 females with an age of(50.6±10.7)years.According to the Ameri-can Spinal Injury Association(ASIA)grading,there were 1 case of grade A,8 cases of grade B,18 cases of grade C,and 16 cases of grade D.The Japanese Orthopaedic Association(JOA)score was(7.9±1.6)points.Anterior cervical decompression,fusion and internal fixation were conducted for 42 patients,and poste-rior total laminectomy and internal fixation for 1 patient.The clinical and imaging manifestations of the pa-tients,and the consistency between preoperative and intraoperative diagnosis of disco-ligamentous complex(DLC)injury were analyzed.ASIA grading and JOA score were used to assess the outcomes of surgical treatment and comparisons were made between preoperation and postoperation.Results DLC injury existed at 99 levels(43 cases),with a high incidence at level C5-6(30 cases),and high-signal manifestations of cervical cord injury existed at 48 levels,with a high incidence at level C3.4(16 cases).Two-segment DLC injury was the most com-mon[74.4％(32/43)],while three-segment DLC injury existed in 9 cases and four-segment DLC injury in 2 cases.There were 21 cases of jumping MDLC injury and 22 cases of continuous MDLC injury.At preoperation,DLC injury was suspected in 10 patients(at 11 levels),of whom 8(at 9 levels)were diagnosed intraoperatively with DLC injury,and 2(at 2 levels)were excluded from the DLC injury.All the 43 patients were followed up for(54.7±10.7)months.By the ASIA grading at the last follow-up,3 cases were grade C,13 cases grade D,and 27 cases grade E.The JOA score at the last follow-up was(15.1±2.2)points.Both the 2 outcomes showed significant improvements compared with the preoperative values(P＜0.05).Conclusions The clinical incidence of cervical hyperextension injury combined with MDLC injury is low,but relatively higher in the middle-aged and elderly patients.As the level of DLC injury is often inconsistent with the likely level of cervical spinal cord injury,surgical exploration of the DLC structure with suspected injury can reduce the rate of missed diagnosis and misdiagnosis.
关键词
颈椎/颈椎飞鞭损伤/脊髓损伤/椎间盘韧带复合体/治疗Key words
Cervical vertebrae/Whiplash injuries/Spinal cord injuries/Disco-ligamentous complex/Therapy引用本文复制引用
出版年
2024
NETL
NSTL
万方数据